nach oben

Erschienen in:

2018 | OriginalPaper | Buchkapitel

5. Analfissur

verfasst von : PD Dr. med. S. Kersting, Dr. med. E. Berg

Erschienen in: Chirurgische Proktologie

Verlag: Springer Berlin Heidelberg

Einloggen, um Zugang zu erhalten

Zusammenfassung

Die Analfissur gehört zu den häufigsten proktologischen Erkrankungen. Durch Einreißen des Anoderms kann es zu einer Überdehnung des Analkanals mit Ausbildung einer Analfissur kommen. Die Fissur beginnt am anokutanen Übergang und kann sich nach oral bis zur Linea dentata ausdehnen. Typische Analfissuren finden sich meist bei 6 Uhr SSL. Die Therapie der Analfissur erfolgt primär konservativ. Alle operativen Eingriffe bei Analfissuren bergen das Risiko der postoperativen Sphinkterinsuffizienz mit der Folge einer Stuhlinkontinenz. Daher sollte nur nach Ausschöpfung aller konservativen und medikamentösen Maßnahmen eine Operation in Erwägung gezogen werden. Im deutschsprachigen Raum hat sich als sphinkterschonendes Verfahren die Fissurektomie mit Exzision der Fissur einschließlich Vorpostenfalte, hypertropher Analpapille, Mariske, vertieften Krypten, ggf. vorliegender Fistel und Narbenrändern als operative Therapie der Wahl etabliert.

Abramowitz L, Bouchard D, Souffran M, Devulder F, et al. (2013) Sphincter-sparing anal-fissure surgery: a 1-year prospective, observational, multicentre study of fissurectomy with anoplasty. Colorectal Dis 15: 359–367

Agrawal V, Kaushal G, Gupta R (2013) Randomized controlled pilot trial of nifedipine as oral therapy vs. topical application in the treatment of fissure-in-ano. Am J Surg 206: 748–751

Altomare DF, Binda GA, Canuti S, Landolfi V, et al. (2011) The management of patients with primary chronic anal fissure: a position paper. Tech Coloproctol 15: 135–141

Altunrende B, Sengul N, Arisoy O, Yilmaz EE (2013) Transcutaneous electrical posterior tibial nerve stimulation for chronic anal fissure: a preliminary study. Int J Colorectal Dis 28: 1583–1589

Araujo SE, Sousa MM, Caravatto PP, Habr-Gamai A, et al. (2010) Early and late results of topical diltiazem and bethanechol for chronic anal fissure: a comparative study. Hepatogastroenterology 57: 81–85

Arroyo A, Perez F, Serrano P, Candela F, et al. (2005) Long-term results of botulinum toxin for the treatment of chronic anal fissure: prospective clinical and manometric study. Int J Colorectal Dis 20: 267–271

Arslan K, Erenoglu B, Dogru O, Kokcam S, et al. (2012) Effect of chronic anal fissure components on isosorbide dinitrate treatment. World J Surg 36: 2225–2229

Asim M, Lowrie N, Stewart J, Lolohea S, et al. (2014) Botulinum toxin versus botulinum toxin with low-dose glyceryltrinitrate for healing of chronic anal fissure: a prospective, randomised trial. N Z Med J 127: 80–86

Ayantunde AA, Debrah SA (2006) Current concepts in anal fissures. World J Surg 30: 2246–2260

Aysan E, Aren A, Ayar E (2004) A prospective, randomized, controlled trial of primary wound closure after lateral internal sphincterotomy. Am J Surg 187: 291–294

Bailey HR, Beck DE, Billingham RP, Binderow SR, et al. (2002) A study to determine the nitroglycerin ointment dose and dosing interval that best promote the healing of chronic anal fissures. Dis Colon Rectum 45: 1192–1199

Ballester C, Sarria B, Garcia-Granero E, Morcillo EJ, et al. (2007) Relaxation of the isolated human internal anal sphincter by sildenafil. Br J Surg 94: 894–902

Barnes TG, Zafrani Z, Abdelrazeq AS (2015) Fissurectomy Combined with High-Dose Botulinum Toxin Is a Safe and Effective Treatment for Chronic Anal Fissure and a Promising Alternative to Surgical Sphincterotomy. Dis Colon Rectum 58: 967–973

Brisinda G, Maria G, Bentivoglio AR, Cassetta E, et al. (1999) A comparison of injections of botulinum toxin and topical nitroglycerin ointment for the treatment of chronic anal fissure. N Engl J Med 341: 65–69

Carapeti EA, Kamm MA, McDonald PJ, Chadwick SJ, et al. (1999) Randomised controlled trial shows that glyceryl trinitrate heals anal fissures, higher doses are not more effective, and there is a high recurrence rate. Gut 44: 727–730

Carapeti EA, Kamm MA, Phillips RK (2000) Topical diltiazem and bethanechol decrease anal sphincter pressure and heal anal fissures without side effects. Dis Colon Rectum 43: 1359–1362

Casillas S, Hull TL, Zutshi M, Trzcinski R, et al. (2005) Incontinence after a lateral internal sphincterotomy: are we underestimating it? Dis Colon Rectum 48: 1193–1199

Chambers W, Sajal R, Dixon A (2010) V-Y advancement flap as first-line treatment for all chronic anal fissures. Int J Colorectal Dis 25: 645–648

Chen HL, Woo XB, Wang HS, Lin YJ, et al. (2014) Botulinum toxin injection versus lateral internal sphincterotomy for chronic anal fissure: a meta-analysis of randomized control trials. Tech Coloproctol 18: 693–698

D’Ugo S, Franceschilli L, Cadeddu F, Leccesi L, et al. (2013) Medical and surgical treatment of haemorrhoids and anal fissure in Crohn’s disease: a critical appraisal. BMC Gastroenterol 13: 47

da Silva Fernandes GO, Murad-Regadas SM, Pinheiro Regadas FS, Rodrigues LV, et al. (2014) Clinical, functional and morphologic evaluation of patients undergoing lateral sphincterotomy for chronic anal fissure treatment. Identification of factors that can interfere with fecal continence. J Coloproctol 34: 174–180

Davies I, Dafydd L, Davies L, Beynon J (2014) Long term outcomes after lateral anal sphincterotomy for anal fissure: a retrospective cohort study. Surg Today 44: 1032–1039

Dessily M, Charara F, Chelala E, Donfut AL, et al. (2014) Injection of a sclerosing agent as first line treatment in anal fissure. Acta Chir Belg 114: 261–265

Digennaro R, Pecorella G, La Manna S, Alderisio A, et al. (2015) Prospective multicenter observational trial on the safety and efficacy of LEVORAG(R) Emulgel in the treatment of acute and chronic anal fissure. Tech Coloproctol 19: 287–292

Dodi G, Bogoni F, Infantino A, Pianon P, et al. (1986) Hot or cold in anal pain? A study of the changes in internal anal sphincter pressure profiles. Dis Colon Rectum 29: 248–251

Eisenhammer S (1959) The evaluation of the internal anal sphincterotomy operation with special reference to anal fissure. Surg Gynecol Obstet 109: 583–590

Engel AF, Eijsbouts QA, Balk AG (2002) Fissurectomy and isosorbide dinitrate for chronic fissure in ano not responding to conservative treatment. Br J Surg 89: 79–83

Esfahani MN, Madani G, Madhkhan S (2015) A novel method of anal fissure laser surgery: a pilot study. Lasers Med Sci 30: 1711–1717

Gabriel WB (1939) Anal Fissure. Br Med J 1: 519–521

Gagliardi G, Pascariello A, Altomare DF, Arcana F, et al. (2010) Optimal treatment duration of glyceryl trinitrate for chronic anal fissure: results of a prospective randomized multicenter trial. Tech Coloproctol 14: 241–248

Gandomkar H, Zeinoddini A, Heidari R, Amoli HA (2015) Partial lateral internal sphincterotomy versus combined botulinum toxin A injection and topical diltiazem in the treatment of chronic anal fissure: a randomized clinical trial. Dis Colon Rectum 58: 228–234

Garcia-Aguilar J, Belmonte Montes C, Perez JJ, Jensen L, et al. (1998) Incontinence after lateral internal sphincterotomy: anatomic and functional evaluation. Dis Colon Rectum 41: 423–427

Garcia-Granero E, Sanahuja A, Garcia-Armengol J, Jimenez E, et al. (1998) Anal endosonographic evaluation after closed lateral subcutaneous sphincterotomy. Dis Colon Rectum 41: 598–601

Garcia-Granero E, Sanahuja A, Garcia-Botello SA, Faiz O, et al. (2009) The ideal lateral internal sphincterotomy: clinical and endosonographic evaluation following open and closed internal anal sphincterotomy. Colorectal Dis 11: 502–507

Garg P, Garg M, Menon GR (2013) Long-term continence disturbance after lateral internal sphincterotomy for chronic anal fissure: a systematic review and meta-analysis. Colorectal Dis 15: e104–e117

Garrido R, Lagos N, Lagos M, Rodriguez-Navarro AJ, et al. (2007) Treatment of chronic anal fissure by gonyautoxin. Colorectal Dis 9: 619–624

Gee T, Hisham RB, Jabar MF, Gul YA (2013) Ano-coccygeal support in the treatment of idiopathic chronic posterior anal fissure: a prospective non-randomised controlled pilot trial. Tech Coloproctol 17: 181–186

Giordano P, Gravante G, Grondona P, Ruggiero B, et al. (2009) Simple cutaneous advancement flap anoplasty for resistant chronic anal fissure: a prospective study. World J Surg 33: 1058–1063

Gosselink MP, Darby M, Zimmerman DD, Gruss HJ, et al. (2005) Treatment of chronic anal fissure by application of L-arginine gel: a phase II study in 15 patients. Dis Colon Rectum 48: 832–837

Graziano A, Svidler Lopez L, Lencinas S, Masciangioli G, et al. (2001) Long-term results of topical nitroglycerin in the treatment of chronic anal fissures are disappointing. Tech Coloproctol 5: 143–147

Griffin N, Zimmerman DD, Briel JW, Gruss HJ, et al. (2002) Topical L-arginine gel lowers resting anal pressure: possible treatment for anal fissure. Dis Colon Rectum 45: 1332–1336

Gupta P (2006) Randomized, controlled study comparing sitz-bath and no-sitz-bath treatments in patients with acute anal fissures. ANZ J Surg 76: 718–721

Hancke E, Rikas E, Suchan K, Volke K (2010) Dermal flap coverage for chronic anal fissure: lower incidence of anal incontinence compared to lateral internal sphincterotomy after long-term follow-up. Dis Colon Rectum 53: 1563–1568

Hasse C, Brune M, Bachmann S, Lorenz W, et al. (2004) Laterale, partielle Sphinkteromyotomie zur Therapie der chronischen Analfissur. Langzeitergebnisse einer epidemiologischen Kohortenstudie. Chirurg 75: 160–167

Heitland W (2012) Perianale Fistel und Analfissur. Chirurg 83: 1033–1039

Herzig DO, Lu KC (2010) Anal fissure. Surg Clin North Am 90: 33–44, Table of Contents

Jensen SL (1986) Treatment of first episodes of acute anal fissure: prospective randomised study of lignocaine ointment versus hydrocortisone ointment or warm sitz baths plus bran. Br Med J (Clin Res Ed) 292: 1167–1169

Jonas M, Lund JN, Scholefield JH (2002) Topical 0.2 % glyceryl trinitrate ointment for anal fissures: long-term efficacy in routine clinical practice. Colorectal Dis 4: 317–320

Joos AK, Bussen D, Herold A (2009) Abszess, Analfistel, Analfissur. Allgemein- und Viszeralchirurgie up2date 4: 221–236

Kang WH, Lim CH, Choi DH, Shin HK, et al. (2014) Comparison of skin incisions used for open lateral internal sphincterotomies – radial versus circumferential incisions: a retrospective cohort study. Int J Surg 12: 1141–1145

Kersting S, Loch H, Jung K-P, Berg E (2015) Proktologische Probleme in der Schwangerschaft und postpartal. CHAZ: 577–581

Khaikin M, Bashankaev B, Sands D, Weiss EG, et al. (2014) The effect of topical anal captopril on resting anal pressure in healthy volunteers: the first human pilot study. Tech Coloproctol 18: 39–43

Klosterhalfen B, Vogel P, Rixen H, Mittermayer C (1989) Topography of the inferior rectal artery: a possible cause of chronic, primary anal fissure. Dis Colon Rectum 32: 43–52

Kocher HM, Steward M, Leather AJ, Cullen PT (2002) Randomized clinical trial assessing the side-effects of glyceryl trinitrate and diltiazem hydrochloride in the treatment of chronic anal fissure. Br J Surg 89: 413–417

Kolbert G, Stoll M (2016) Leitliniengerechte Therapie der Analfissur. Coloproctology 38: 339. doi 10.1007/s00053-016-0100-9

Larpent JL, Dussaud F, Gorce D, Lunaud B, et al. (1996) The use of glyceryl trinitrate in inexaminable patients with anal fissure. Int J Colorectal Dis 11: 263

Levin A, Cohen MJ, Mindrul V, Lysy J (2011) Delayed fecal incontinence following surgery for anal fissure. Int J Colorectal Dis 26: 1595–1599

Lord PH (1968) A new regime for the treatment of haemorrhoids. Proc R Soc Med 61: 935–936

Lund JN (2007) Evidenzbasierter Algorithmus zur Therapie von Analfissuren. Coloproctology 29: 1–5

Lund JN, Scholefield JH (1996) Aetiology and treatment of anal fissure. Br J Surg 83: 1335–1344

Lund JN, Binch C, McGrath J, Sparrow RA, et al. (1999) Topographical distribution of blood supply to the anal canal. Br J Surg 86: 496–498

Lysy J, Israelit-Yatzkan Y, Sestiery-Ittah M, Weksler-Zangen S, et al. (2001) Topical nitrates potentiate the effect of botulinum toxin in the treatment of patients with refractory anal fissure. Gut 48: 221–224

MacDonald A, Smith A, McNeill AD, Finlay IG (1992) Manual dilatation of the anus. Br J Surg 79: 1381–1382

Magdy A, El Nakeeb A, Fouda el Y, Youssef M, et al. (2012) Comparative study of conventional lateral internal sphincterotomy, V-Y anoplasty, and tailored lateral internal sphincterotomy with V-Y anoplasty in the treatment of chronic anal fissure. J Gastrointest Surg 16: 1955–1962

Marino F, Bottalico M (2013) The daily intake of Tadalafil 5 mg improves the symptoms of chronic anal fissure. Colorectal Dis 15: 1315

Minguez M, Herreros B, Espi A, Garcia-Granero E, et al. (2002) Long-term follow-up (42 months) of chronic anal fissure after healing with botulinum toxin. Gastroenterology 123: 112–117

Mlitz H, Püschel W, Bohle RM (2012) Sekundäre Analfissur infolge Leishmaniose. Coloproctology 34: 144–145

Murad-Regadas SM, Fernandes GO, Regadas FS, Rodrigues LV, et al. (2013) How much of the internal sphincter may be divided during lateral sphincterotomy for chronic anal fissure in women? Morphologic and functional evaluation after sphincterotomy. Dis Colon Rectum 56: 645–651

Naldini G, Cerullo G, Mascagni D, Orlandi S, et al. (2012) Hiding intersphincteric and transphincteric sepsis in a novel pathological approach to chronic anal fissure. Surg Innov 19: 33–36

Nasr M, Ezzat H, Elsebae M (2010) Botulinum toxin injection versus lateral internal sphincterotomy in the treatment of chronic anal fissure: a randomized controlled trial. World J Surg 34: 2730–2734

Nelson RL, Chattopadhyay A, Brooks W, Platt I, et al. (2011) Operative procedures for fissure in ano. Cochrane Database Syst Rev: CD002199

Nelson RL, Thomas K, Morgan J, Jones A (2012) Non surgical therapy for anal fissure. Cochrane Database Syst Rev: CD003431

Notaras MJ (1969) Lateral subcutaneous sphincterotomy for anal fissure--a new technique. Proc R Soc Med 62: 713

Nyam DC, Wilson RG, Stewart KJ, Farouk R, et al. (1995) Island advancement flaps in the management of anal fissures. Br J Surg 82: 326–328

O’Kelly TJ (1996) Nerves that say NO: a new perspective on the human rectoanal inhibitory reflex. Ann R Coll Surg Engl 78: 31–38

Ommer A (2015) Komplikationsmanagement in der Fissur- und Fistelchirurgie. Chirurg 86: 734–740

Ouaissi M, Giger U, Sielezneff I, Yawovi KA, et al. (2011) Mucosal advancement flap anoplasty for chronic anal fissure resistant to conservative therapy. World J Surg 35: 900–904

Parks AG (1967) The management of fissure in ano. Hosp Med 1: 737

Patel SD, Oxenham T, Praveen BV (2011) Medium-term results of anal advancement flap compared with lateral sphincterotomy for the treatment of anal fissure. Int J Colorectal Dis 26: 1211–1214

Patti R, Guercio G, Territo V, Aiello P, et al. (2012) Advancement flap in the management of chronic anal fissure: a prospective study. Updates Surg 64: 101–106

Perry WB, Dykes SL, Buie WD, Rafferty JF (2010) Practice parameters for the management of anal fissures (3rd revision). Dis Colon Rectum 53: 1110–1115

Pujahari AK (2010) Unilateral versus bilateral lateral internal sphincterotomy: a randomized controlled trial for chronic fissure in ano. Trop Gastroenterol 31: 69–71

Rakinic J (2007) Anal fissure. Clin Colon Rectal Surg 20: 133–137

Rattan S, Chakder S (1992) Role of nitric oxide as a mediator of internal anal sphincter relaxation. Am J Physiol 262: G107–G112

Raulf F, Meier zu Eissen J, Furtwängler A, Herold A, et al. (2009) Leitlinie: Analfissur. Coloproctology 31: 201–204

Renzi A, Izzo D, Di Sarno G, Talento P, et al. (2008) Clinical, manometric, and ultrasonographic results of pneumatic balloon dilatation vs. lateral internal sphincterotomy for chronic anal fissure: a prospective, randomized, controlled trial. Dis Colon Rectum 51: 121–127

Renzi A, Brillantino A, Di Sarno G, D’Aniello F, et al. (2015) Myoxinol (Hydrolyzed Hibiscus esculentus Extract) in the Cure of Chronic Anal Fissure: Early Clinical and Functional Outcomes. Gastroenterol Res Pract 2015: 567920

Sajid MS, Vijaynagar B, Desai M, Cheek E, et al. (2008) Botulinum toxin vs glyceryltrinitrate for the medical management of chronic anal fissure: a meta-analysis. Colorectal Dis 10: 541–546

Samim M, Twigt B, Stoker L, Pronk A (2012) Topical diltiazem cream versus botulinum toxin a for the treatment of chronic anal fissure: a double-blind randomized clinical trial. Ann Surg 255: 18–22

Schiano di Visconte M, Di Bella R, Munegato G (2006) Randomized, prospective trial comparing 0.25 percent glycerin trinitrate ointment and anal cryothermal dilators only with 0.25 percent glycerin trinitrate ointment and only with anal cryothermal dilators in the treatment of chronic anal fissure: a two-year follow-up. Dis Colon Rectum 49: 1822–1830

Scholefield JH, Bock JU, Marla B, Richter HJ, et al. (2003) A dose finding study with 0.1 %, 0.2 %, and 0.4 % glyceryl trinitrate ointment in patients with chronic anal fissures. Gut 52: 264–269

Scholz T, Hetzer FH, Dindo D, Demartines N, et al. (2007) Long-term follow-up after combined fissurectomy and Botox injection for chronic anal fissures. Int J Colorectal Dis 22: 1077–1081

Schouten WR, Briel JW, Boerma MO, Auwerda JJ, et al. (1996) Pathophysiological aspects and clinical outcome of intra-anal application of isosorbide dinitrate in patients with chronic anal fissure. Gut 39: 465–469

Shao WJ, Li GC, Zhang ZK (2009) Systematic review and meta-analysis of randomized controlled trials comparing botulinum toxin injection with lateral internal sphincterotomy for chronic anal fissure. Int J Colorectal Dis 24: 995–1000

Sileri P, Stolfi VM, Franceschilli L, Grande M, et al. (2010) Conservative and surgical treatment of chronic anal fissure: prospective longer term results. J Gastrointest Surg 14: 773–780

Sinha R, Kaiser AM (2011) Efficacy of management algorithm for reducing need for sphincterotomy in chronic anal fissures. Colorectal Dis 14: 760–764

Tan KY, Seow-Choen F, Hai CH, Thye GK (2009) Posterior perineal support as treatment for anal fissures--preliminary results with a new toilet seat device. Tech Coloproctol 13: 11–15

Theodoropoulos GE, Spiropoulos V, Bramis K, Plastiras A, et al. (2015) Dermal flap advancement combined with conservative sphincterotomy in the treatment of chronic anal fissure. Am Surg 81: 133–142

Torrabadella L, Salgado G, Burns RW, Berman IR (2004) Manometric study of topical sildenafil (Viagra) in patients with chronic anal fissure: sildenafil reduces anal resting tone. Dis Colon Rectum 47: 733–738

Utzig MJ, Kroesen AJ, Buhr HJ (2003) Concepts in pathogenesis and treatment of chronic anal fissure--a review of the literature. Am J Gastroenterol 98: 968–974

Wald A, Bharucha AE, Cosman BC, Whitehead WE (2014) ACG clinical guideline: management of benign anorectal disorders. Am J Gastroenterol 109: 1141–1157 (Quiz) 1058

Whatley JZ, Tang SJ, Glover PH, Davis ED, et al. (2015) Management of complicated chronic anal fissures with high-dose circumferential chemodenervation (HDCC) of the internal anal sphincter. Int J Surg 24: 24–26

Wienert V, Raulf F, Mlitz H (2012) Analfissur: Symptome, Diagnose und Therapien. Epubli. ISBN 3844227822, 9783844227826

Winkler R (2012) Analfissur. In: Lange J, Mölle B, Girona J (Hrsg) Chirurgische Proktologie, 2. Aufl. Springer, Berlin Heidelberg

Yakovlev A, Karasev SA, Dolgich OY (2011) Sacral nerve stimulation: a novel treatment of chronic anal fissure. Dis Colon Rectum 54: 324–327

Yiannakopoulou E (2012) Botulinum toxin and anal fissure: efficacy and safety systematic review. Int J Colorectal Dis 27: 1–9

Youssef T, Youssef M, Thabet W, Lotfy A, et al. (2015) Randomized clinical trial of transcutaneous electrical posterior tibial nerve stimulation versus lateral internal sphincterotomy for treatment of chronic anal fissure. Int J Surg 22: 143–148

Yurko Y, Crockett JA, Culumovic PJ (2014) The efficacy and morbidity of different surgical treatment techniques for chronic anal fissure: an academic colorectal experience. Am Surg 80: 241–244

Zhoubie N, Stoll M, Winkler R, Shekarriz H (2006) Irrwege in der Behandlung chronischer Analfissuren – ein Erfahrungsbericht über 1001 Fälle. 123. Kongress der Deutschen Gesellschaft für Chirurgie. http://www.egms.de/static/de/meetings/dgch2006/06dgch141.shtml. (Zugriff 17.05.2017)

Titel: Analfissur
verfasst von: PD Dr. med. S. Kersting
Dr. med. E. Berg
Verlag: Springer Berlin Heidelberg
Buch: Chirurgische Proktologie
Print ISBN: 978-3-662-54681-9

Electronic ISBN: 978-3-662-54682-6

Copyright-Jahr: 2018
DOI: https://doi.org/10.1007/978-3-662-54682-6_5

Neu im Fachgebiet Chirurgie

23.04.2024 | Ablationstherapie | Nachrichten

Wie erfolgreich ist eine Re-Ablation nach Rezidiv?

23.04.2024 | Appendizitis | Nachrichten

Hinter dieser Appendizitis steckte ein Erreger

23.04.2024 | Operationsvorbereitung | Nachrichten

Mehr Schaden als Nutzen durch präoperatives Aussetzen von GLP-1-Agonisten?

19.04.2024 | EAU 2024 | Kongressbericht | Nachrichten

Ureterstriktur: Innovative OP-Technik bewährt sich

weitere anzeigen

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Aktuelle BDC Leitlinien-Webinare

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

Karpaltunnelsyndrom BDC Leitlinien Webinare

CME: 2 Punkte

Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis

S2e-Leitlinie „Distale Radiusfraktur“

Radiusfraktur BDC Leitlinien Webinare

CME: 2 Punkte

Das Webinar beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske

Dr. med. Benjamin Meyknecht

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

Appendizitis BDC Leitlinien Webinare

CME: 2 Punkte

Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric

Springer Medizin

Zusammenfassung

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Neu im Fachgebiet Chirurgie

Wie erfolgreich ist eine Re-Ablation nach Rezidiv?

Hinter dieser Appendizitis steckte ein Erreger

Mehr Schaden als Nutzen durch präoperatives Aussetzen von GLP-1-Agonisten?

Ureterstriktur: Innovative OP-Technik bewährt sich

Update Chirurgie

Aktuelle BDC Leitlinien-Webinare

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

S2e-Leitlinie „Distale Radiusfraktur“

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“